Anette Andersen

Pathways and mechanisms in adolescence contribute to adult health inequalities

Aims: This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerability. Methods: We conducted literature searches in English-language peer-reviewed journals using PubMed (from 1966 to May 2009) and PsycINFO, and combined these with hand-searches of reference lists, journals, and authors of particular relevance. Results: Most health indicators are socially patterned in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social patterning of alcohol use is less consistent. Relational dimensions like lone parenthood and bullying are socially patterned and track over time, and there are indications of a socially differential vulnerability to the effects of these types of relational strain. Very little research has investigated the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment. Conclusions: We find the Adolescent Pathway Model useful for providing an overview of what elements and mechanisms in adolescence may be of special importance for adult health inequalities. There is a lack of knowledge of how social patterns of health, health behaviours, and social relations in adolescence transfer into adulthood and to what extent they reflect themselves in adult health.

Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark

OBJECTIVE. The goal was to examine whether being a victim of bullying was associated with medicine use, taking into account the increased prevalence of physical and psychological symptoms. METHODS. The study population included all students in grades 5, 7, and 9 (mean ages: 11.6, 13.6, and 15.6 years, respectively) in a random sample of schools in Denmark (participation rate: 88.5%; N = 5205). The students reported health problems, medicine use, bullying, and a range of psychosocial conditions in an anonymous standardized questionnaire. The outcome measure was self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness. The determinant was frequency of exposure to bullying, measured with 1 item. RESULTS. In multivariate models adjusted for age and social class, we found that adolescent victims of bullying used medicine for pains and psychological problems more often than did adolescents who were not bullied. The increased odds of using medicine were not explained by the higher prevalence of symptoms among the bullied children. CONCLUSIONS. We found victimization from bullying to be associated with medicine use, even when we controlled for the higher prevalence of symptoms among bullied victims. The medications that adolescents use can have adverse effects, in addition to the potentially health-damaging effects of bullying. Policy makers, health care professionals, and school staff should be aware that the adolescent victims of bullying are prone to excess use of medicine, and preventive actions should be taken to decrease the level of bullying as well as the use of medicine among adolescents.

Measurement of Ethnic Background in Cross-national School Surveys: Agreement Between Students' and Parents' Responses

PURPOSE Indicators such as country of birth and language spoken at home have been used as proxy measures for ethnic background, but the validity of these indicators in surveys among school children remains unclear. This study aimed at comparing item response and student-parent agreement on four questions about country of birth and language spoken at home in three European countries. METHODS We analyzed data from the Health Behaviour in School-aged Children (HBSC) Child-Parent Validation Study 2005, including 486 matched student-parent pairs from Denmark, Hungary, and Scotland. Selected items from the internationally standardized HBSC questionnaire were completed by 11-year-old students and their parents. We examined item response and student-parent agreement on the four HBSC Ethnic Background Indicators: the students country of birth, mothers country of birth, fathers country of birth, and language usually spoken at home. RESULTS All item response rates were high for both students (>92%) and parents (>96%). The percent student-parent agreement was high on all four items (>97%). The strength of agreement ranged from good to excellent for all items indicated by the kappa value (between .60 and 1.00). Results were robust across countries. CONCLUSIONS Our findings suggest that students as young as 11 years are able to provide valid responses to four simple questions about country of birth and language spoken at home. The four HBSC Ethnic Background Indicators can be useful in epidemiologic studies on identification of subgroups that may receive unequal prevention services or in assessment of how risk factors, symptoms, and diseases may differ by ethnic background among school children.

Self-reported recurrent pain and medicine use behaviours among 15-year olds: results from the international study.

There is considerable variation in adolescent pain prevalence across epidemiological studies, with limited information on pain‐related behaviours among adolescents, including medicine use. The aims of this study were (1) to examine the prevalence of recurrent pain among 15‐year‐old adolescents internationally; (2) to investigate the association between recurrent pain and medicine use behaviours among boys and girls; and (3) to evaluate the consistency of these associations across countries.

Stress and medicine use for headache: does sense of coherence modify the association?

BACKGROUND Medicine use as a strategy for coping with daily stressors is an under-studied issue. Studies show that stress is associated with use of over-the-counter medicine, but the underlying mechanisms are not well understood. The aim of this study was to examine whether sense of coherence (SOC) modifies the association between perceived stress and medicine use for headache. METHODS National cross-sectional study in Denmark. STUDY POPULATION men and women aged 25-44 years, n = 990. The survey was conducted by web-based questionnaires and telephone interviews. The outcome measure was medicine use for headache. The independent variable was perceived stress. SOC and gender were investigated as moderators. Social class, headache prevalence and severity, and response method were included as co-variates. RESULTS Our study showed that SOC modified the association between stress and medicine use for headache (only statistically significant among women). The odds for medicine use among women who felt stressed were 2.30 (1.39-3.79) compared to women who did not feel stressed; among men who felt stressed the equivalent odds were 1.46 (0.80-2.66). In analysis stratified by SOC, the odds for medicine use when stressed were 2.09 (0.71-6.21) among women with high SOC, 2.21 (1.10-4.41) among women with medium SOC and 3.69 (1.09-12.47) among women with low SOC. The equivalent odds for men were 1.29 (0.33-5.04), 1.33 (0.59-3.04) and 2.47 (0.57-10.64), respectively. CONCLUSION SOC modifies the association between stress and medicine use especially among women. Individuals with fewer coping resources may be more likely to use medicine beyond indication to treat stress.

Use of over‐the‐counter analgesics and perceived stress among 25–44‐year olds

To examine the association between perceived stress and use of over‐the‐counter analgesics in a representative sample of 25–44‐year old adults, and to examine the association across various socio‐demographic strata. Furthermore, to examine whether an association between perceived stress and use of over‐the‐counter analgesics attenuates when controlled by potential stress‐related pain and discomfort.

Inequalities in asthma treatment among children by country of birth and ancestry: a nationwide study in Denmark

Background Investigations in several Western countries have reported ethnic differences in asthma prevalence and treatment among children and in some countries these differences are increasing. The aim of this study was to analyse whether there are inequalities in asthma treatment by country of birth and ancestry among children residing in Denmark, and whether this potential association may vary between different household income groups. Methods Data were obtained by linking the Danish Civil Registration System, the Central Taxpayers’ Register and the Danish National Prescription Register. Population: the entire population of children in Denmark from 0 to 17 years of age in 2008 (n=1 209 091). Information on asthma treatment was obtained from the National Prescription Register. The analyses included multiple logistic regression models stratified by household income. Results Compared with ethnic Danes, immigrant children had the lowest OR for redeeming a prescription for asthma medication, both relief (OR 0.37; 95% CIs, 0.20 to 0.68) and preventive (OR 0.37; (0.22 to 0.59)). Similar associations were found among descendant children (OR for relief treatment 0.82 (0.79 to 0.89) and for preventive treatment 0.68 (0.61 to 0.75)). The pattern of the association remained after stratifying for household income. Conclusions We found that, inequalities that cannot be explained by household income alone exist in treatments to prevent asthma as well as to relieve symptoms in children residing in Denmark, by country of birth and ancestry. The difference between immigrants and descendants may indicate that unfamiliarity with the Danish healthcare system is a contributory cause of the inadequate treatment of asthma.

Re-visit to the school nurse and adolescents’ medicine use

Objective: To examine if students who re-visit the school nurse use medicines differently than other students when exposed to aches and psychological problems. Methods: The study includes all 11-, 13- and 15-year-old students from a random sample of schools in Denmark, response rate 87 per cent, n = 5,205. The data collection followed the internationally standardized HBSC questionnaire. This study includes an item about students’ re-visits to the school nurse, items about frequency of four complaints (headache, stomach-ache, difficulties in getting to sleep, and nervousness) and medicine use in the past month for these four complaints. Results: In total, 8.6 per cent of the students had re-visited the school nurse. There was a strong and graded association between frequency of complaints and medicine use for the relevant complaint. Students who re-visited the school nurse had higher odds for medicine use than other students. The association between frequency of complaints and medicine use was stronger among students who had not re-visited the school nurse as compared to the students who had re-visited the school nurse. One example is the OR (95 per cent CI) for medicine use for headache among students who experienced headache monthly vs. seldom/never and at least weekly vs. seldom/never. Among students who did not re-visit the school nurse, the OR estimates were 5.32 (4.61–6.14) and 13.6 (10.5–17.6) and among students who did, OR estimates were 3.65 (2.32–5.75) and 7.07 (3.58–14.0). Conclusion: The school nurse may reduce the students’ proneness to use medicine when they experience complaints.

Poor school satisfaction and number of cannabis using peers within school classes as individual risk factors for cannabis use among adolescents

There is little information available on the topic of poor school satisfaction as a risk factor for cannabis use among adolescents. We examined if there was an association between poor school satisfaction, school class cannabis use and individual cannabis use. Further, we investigated if many cannabis users within the school class statistically interacted with poor school satisfaction upon the association with individual cannabis use. A cross-sectional study of 1317 Danish 15-year-olds in 95 school classes in a random sample of schools. The exposure variables were school satisfaction and school class cannabis use. The criterion variable was individual cannabis use, three times or more (last 12 months). Poor school satisfaction (OR 2.78, 95% CL = 1.83—4.23), attending a school class with >2 cannabis users (OR 3.68, 95% CL = 2.21—6.12) were associated with cannabis use. In our study there was not a significant statistically interaction between number of cannabis users in school classes and poor school satisfaction upon individual cannabis use (p = 0.183). We found that poor school satisfaction and school class cannabis use where both associated with higher individual cannabis use. The risk factors did not significantly interact and may suggest that they function as individual exposure factors towards adolescent cannabis use.

Adolescents’ medicine use for headache: secular trends in 20 countries from 1986 to 2010

BACKGROUND This study reports secular trends in medicine use for headache among adolescents in 20 countries from 1986 to 2010. METHODS The international Health Behaviour in School-aged Children (HBSC) survey includes self-reported data about medicine use for headaches among nationally representative samples of 11-, 13- and 15-year-olds. We included 20 countries with data from at least three data collection waves, with a total of 380 129 participants. RESULTS The prevalence of medicine use for headaches varied from 16.5% among Hungarian boys in 1994 to 62.9% among girls in Wales in 1998. The prevalence was higher among girls than boys in every country and data collection year. The prevalence of medicine use for headaches increased in 12 of 20 countries, most notably in the Czech Republic, Poland, Russia, Sweden and Wales. CONCLUSION The prevalence of medicine use for headaches among adolescents is high and increasing in many countries. As some medicines are toxic this may constitute a public health problem.